Sleeve gastrectomy

The removal of the gastric fundus is the most modern bariatric surgical operation and comes as a result of the experience from the previously performed obesity operations. This operation, through its simplicity, demonstrates certain peculiarities with great advantages, which explain its current widespread use.

The procedure involves a longitudinal resection of the stomach where the whole fundus is removed together with a portion of the stomach. The remaining part of the stomach has the shape of a sleeve. This is the reason that this name “sleeve” is given by some to this particular operation. The size of the removed stomach varies among the different surgical schools. The largest removal was named “super sleeve”, a term rather inadequate since the size of the removed stomach does not make it a different operation.

This operation is performed laparoscopically (no incision). Its duration is approximately one hour and usually, there is a hospital stay of three days.

There is a two-way mode of effect for this operation. On the one hand, the volume of the stomach is restricted thus the obese person has the sense of fullness with smaller quantities and, on the other hand, the production of a hormone is reduced which is implicated in the modulation of appetite. This hormone is called ghrelin and is produced at the gastric fundus. Therefore, removal of the gastric fundus reduces the blood levels of ghrelin and subsequently this decreases the obese person’s appetite to eat frequently and consume large amounts of food. This operation does not modify the normal process of digestion.

Gastric fundus removal was initially applied as the first surgical step in the procedure of a gastric bypass. The goal then was, in extremely obese patients, to reduce the degree of obesity with the first operation, so as to perform with the second operation a gastric bypass under much safer conditions. In the course of these operations however, it was proven that most obese patients had extremely satisfactory results simply with the removal of the gastric fundus.

At present, the removal of the gastric fundus is practised as a self-existent operation with particularly good results in people with a very high BMI index value and an impulse to consume large amounts of food. Also it is the best alternative to the gastric band in case that the patient does not accomplish the necessary conditions for it or does not want to follow a programme of periodic adjustments.

It is worth noticing that, according to recent studies, removal of the gastric fundus such as the gastric sleeve does treat type 2 diabetes.